Study: Shifting Culture of Gay Sex—Not PrEP Use—Tied to Spike in STIs

Plus: a vast majority of gay and bi men aren't on PrEP—and many aren't getting regular HIV screenings, either.

A new study from the Williams Institute at UCLA has found that while new HIV diagnoses are generally declining among gay and bi men in the United States, only a small percentage of eligible people are actively taking pre-exposure prophylaxis (PrEP) to prevent HIV.

The report, issued earlier this month, found that only 4% of men who have sex with other men (MSM) across all age groups are on PrEP. Worse, researchers discovered that most MSM ages 18–25 aren’t getting regular HIV screenings—including a staggering 25% of younger MSM who’ve never been tested.

Phillip Hammack, a professor University of California, Santa Cruz and the study’s lead author, told the Los Angeles Blade that his team found “misinformation” and “a fair amount of sexual shame” were both to blame for MSM not pursuing PrEP as a preventative treatment: “’Well, I don’t want to be considered a PrEP whore’—that kind of language.”

There were some positive outcomes of the study, though: Researchers also found that black MSM were getting tested more regularly than white MSM. This suggests that campaigns to target HIV screenings and preventative healthcare toward gay and bi men of color—who are most at risk of being diagnosed with HIV over their lifetimes—have been successful.

Some HIV/AIDS activists believe that drug manufacturers’ patent on PrEP, known by its brand name Truvada in the U.S., is making the potentially life-saving drug inaccessible to some of the country’s most vulnerable populations. In July, activists from ACT UP and BreakThePatent.org joined forces to urge the FDA to break the patent on PrEP, effectively lowering its cost.

Without insurance, Truvada reportedly costs $1,600 for a 30-day supply, while the drug itself costs $6 to make per month.

However, healthcare experts assert that the drug is accessible to those who have Medicaid or private health insurance—especially since Gilead, its manufacturer, participates in programs like Patient Advocate Foundation Co-Pay Relief, which alleviate co-pay costs for low-income Americans.

Justin Sullivan/Getty Images

While new HIV diagnoses in the U.S. are generally on the decline, barring certain populations and geographic pockets, STI prevalence among gay and bisexual men—including infections like drug-resistant gonorrhea—is actually on the rise nationwide.

Many have argued that the availability of PrEP (and the subsequent lessened fear of contracting HIV) has encouraged riskier sexual behavior among MSM, like not using condoms or not getting regular STI screenings. But Hammack also told Los Angeles Blade that this isn’t what he’s observed, at least not that simply: “Our data don’t support the idea that we can attribute the rise in STIs to PrEP use, at least not in a direct manner. I personally don’t think that’s what’s happening.”

Hammack added that a “culture shift about sex”—including easy hookups via dating apps and a decreased fear of contracting HIV—is a more likely link to the trends researchers are seeing: “More people are having sex today. We’re in sort of a quiet sexual revolution when it comes to new identities, new labels, and sexual behavior.”

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